Adolescents’ Experiences of Close Relatives Having Physical Illness, Mental Illness, Addiction/Gambling Disorders, or Death Are Associated with Poor Mental Health and Non-Suicidal Self-Injury
Abstract
:1. Introduction
2. Materials and Methods
2.1. Measurements and Definitions
2.2. Statistical Methods
3. Results
3.1. Relatives with Severe Health Conditions (RSHC)
3.1.1. Adolescents’ Mental Health
3.1.2. RSHC and Poor Mental Health
3.1.3. RSHC and Non-Suicidal Self-Injury
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Sieh, D.S.; Visser-Meily, J.M.A.; Meijer, A.M. Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents. J. Child Fam. Stud. 2013, 22, 209–218. [Google Scholar] [CrossRef] [PubMed]
- Radicke, A.; Barkmann, C.; Adema, B.; Daubmann, A.; Wegscheider, K.; Wiegand-Grefe, S. Children of Parents with a Mental Illness: Predictors of Health-Related Quality of Life and Determinants of Child–Parent Agreement. Int. J. Environ. Res. Public. Health 2021, 18, 379. [Google Scholar] [CrossRef] [PubMed]
- Reupert, A.E.; Maybery, D.J.; Kowalenko, N.M. Children whose parents have a mental illness: Prevalence, need and treatment. Med. J. Aust. 2013, 199, 7–9. [Google Scholar] [CrossRef] [PubMed]
- McKenzie Smith, M.; Pinto Pereira, S.; Chan, L.; Rose, C.; Shafran, R. Impact of Well-being Interventions for Siblings of Children and Young People with a Chronic Physical or Mental Health Condition: A Systematic Review and Meta-Analysis. Clin. Child Fam. Psychol. Rev. 2018, 21, 246–265. [Google Scholar] [CrossRef] [PubMed]
- Jernbro, C.; Tindberg, Y.; Janson, S. High risk of severe child abuse and poly-victimisation in families with parental substance misuse—Results from a swedish school-based survey. Child Abuse Rev. 2022, 31, e2741. [Google Scholar] [CrossRef]
- Rostila, M.; Berg, L.; Saarela, J.; Kawachi, I.; Hjern, A. Experience of sibling death in childhood and risk of psychiatric care in adulthood: A national cohort study from Sweden. Eur. Child Adolesc. Psychiatry 2019, 28, 1581–1588. [Google Scholar] [CrossRef]
- Martikainen, P.; Korhonen, K.; Moustgaard, H.; Aaltonen, M.; Remes, H. Substance abuse in parents and subsequent risk of offspring psychiatric morbidity in late adolescence and early adulthood: A longitudinal analysis of siblings and their parents. Soc. Sci. Med. 2018, 217, 106–111. [Google Scholar] [CrossRef]
- Berg, L.; Rostila, M.; Hjern, A. Parental death during childhood and depression in young adults—A national cohort study. J. Child Psychol. Psychiatry 2016, 57, 1092–1098. [Google Scholar] [CrossRef]
- Tiikkaja, S.; Tindberg, Y. The association between adolescents’ experiences of close relatives having severe health conditions and poor mental health—A population-based school study. Adolescents 2023, 3, 550–563. [Google Scholar] [CrossRef]
- Dalman, C.; Bremberg, S.; Åhlén, J.; Ohlis, A.; Agardh, E.; Wicks, S.; Lundin, A. Psykiskt Välbefinnande, Psykiska Besvär och Psykiatriska Tillstånd hos Barn och Unga—Begrepp, Mätmetoder och Förekomst; Forte-Forskningsrådet för hälsa, arbetsliv och välfärd: Stockholm, Sweden, 2021; pp. 1–64. [Google Scholar]
- Sawyer, S.M.; Afifi, R.A.; Bearinger, L.H.; Blakemore, S.J.; Dick, B.; Ezeh, A.C.; Patton, G.C. Adolescence: A foundation for future health. Lancet 2012, 379, 1630–1640. [Google Scholar] [CrossRef]
- Ferrari, A.; Santomauro, F.; Mantilla Herrera, A.M.; Shadid, J.; Ashbaugh, C.; Erskine, H.; Charlson, F.J.; Degenhardt, L.; Scott, J.G.; McGrath, J.J.; et al. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022, 9, 137–150. [Google Scholar]
- Statistik om Psykisk Hälsa i Sverige. Available online: https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/psykisk-halsa-och-suicidprevention/statistik-psykisk-halsa/ (accessed on 30 August 2023).
- Klonsky, E.D.; Muehlenkamp, J.J. Self-injury: A research review for the practitioner. J. Clin. Psychol. 2007, 63, 1045–1056. [Google Scholar] [CrossRef] [PubMed]
- Rasmussen, S.; Hawton, K.; Philpott-Morgan, S.; O’Connor, R.C. Why Do Adolescents Self-Harm?: An Investigation of Motives in a Community Sample. Crisis 2016, 37, 176–183. [Google Scholar] [CrossRef] [PubMed]
- Lauw, M.; How, C.H.; Loh, C. Deliberate self-harm in adolescents. Singap. Med. J. 2015, 56, 306–309. [Google Scholar] [CrossRef]
- Lim, K.S.; Wong, C.H.; McIntyre, R.S.; Wang, J.; Zhang, Z.; Tran, B.X.; Tan, W.; Ho, C.; Ho, R. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. Int. J. Environ. Res. Public Health 2019, 16, 4581. [Google Scholar] [CrossRef]
- Tørmoen, A.J.; Myhre, M.; Walby, F.A.; Grøholt, B.; Rossow, I. Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents. Eur. J. Public Health 2020, 30, 688–692. [Google Scholar] [CrossRef]
- Pisinger, V.; Hawton, K.; Tolstrup, J. Self-injury and suicide behavior among young people with perceived parental alcohol problems in Denmark: A school-based survey. Eur. Child Adolesc. Psychiatry 2018, 27, 201–2018. [Google Scholar] [CrossRef]
- Caine, E.D. Self-harm behaviour: Rethinking physical and mental health. Lancet 2012, 380, 1536–1538. [Google Scholar] [CrossRef]
- Fortuna, L.R. Editorial: Disrupting Pathways to Self-Harm in Adolescence: Machine Learning as an Opportunity. J. Am. Acad. Child Adolesc. Psychiatry 2021, 60, 1459–1460. [Google Scholar] [CrossRef]
- Tuisku, V.; Pelkonen, M.; Kiviruusu, O.; Karlsson, L.; Ruuttu, T.; Marttunen, M. Factors associated with deliberate self-harm behaviour among depressed adolescent outpatients. J. Adolesc. 2009, 32, 1125–1136. [Google Scholar] [CrossRef]
- Wlodarczyk, O.; Schwarze, M.; Rumpf, H.J.; Metzner, F.; Pawils, S. Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review. PLoS ONE 2017, 12, e0179140. [Google Scholar] [CrossRef] [PubMed]
- Yamamoto, R.; Keogh, B. Children’s experiences of living with a parent with mental illness: A systematic review of qualitative studies using thematic analysis. J. Psychiatr. Ment. Health Nurs. 2018, 25, 131–141. [Google Scholar] [CrossRef] [PubMed]
- Uh, S.; Dalmaijer, E.S.; Siugzdaite, R.; Ford, T.J.; Astle, D.E. Two Pathways to Self-Harm in Adolescence. J. Am. Acad. Child Adolesc. Psychiatry 2021, 60, 1491–1500. [Google Scholar] [CrossRef] [PubMed]
- Viner, R.; Macfarlane, A. Health promotion. BMJ 2005, 330, 527–529. [Google Scholar] [CrossRef] [PubMed]
- Jørgensen, S.E.; Thygesen, L.C.; Michelsen, S.I.; Due, P.; Bidstrup, P.E.; Høeg, B.L.; Anderssen, A. Why Do Some Adolescents Manage Despite Parental Illness? Identifying Promotive Factors. J. Adolesc. Health 2021, 69, 335–341. [Google Scholar] [CrossRef] [PubMed]
- Kallander, E.K.; Weimand, B.M.; Hanssen-Bauer, K.; Van Roy, B.; Ruud, T. Factors associated with quality of life for children affected by parental illness or substance abuse. Scand. J. Caring Sci. 2021, 35, 405–419. [Google Scholar] [CrossRef]
- Narayan, A.J.; Rivera, L.M.; Bernstein, R.E.; Harris, W.W.; Lieberman, A.F. Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse Negl. 2018, 78, 19–30. [Google Scholar] [CrossRef]
- Almeida, T.C.; Guarda, R.; Cunha, O. Positive childhood experiences and adverse experiences: Psychometric properties of the Benevolent Childhood Experiences Scale (BCEs) among the Portuguese population. Child Abuse Negl. 2021, 120, 105179. [Google Scholar] [CrossRef]
- Lag (2003:460) om Etikprövning av Forskning Som Avser Människor (Swedish Parliament. Ethical Review Act). Available online: https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/lag-2003460-om-etikprovning-av-forskning-som_sfs-2003-460/ (accessed on 30 August 2023).
- Annerbäck, E.M.; Svedin, C.G.; Dahlstrom, Ö. Child physical abuse influencing the associations between self-reported exposure and self-reported health problems: A cross-selectional study. Child Adolesc. Psychiatry Ment. Health 2018, 12, 1–13. [Google Scholar] [CrossRef]
- Noirrit-Esclassan, E.; Annerbäck, E.M.; Cuhna Soares, F.; Dahllöf, G.; Kvist, T. Association between self-reported dental fear and exposure to violence among adolescents-A population-based study. Int. J. Paediatr. Dent. 2022, 32, 812–818. [Google Scholar] [CrossRef]
- Haraldsson, J.; Pingel, R.; Nordgren, L.; Tindberg, Y.; Kristiansson, P. Understanding adolescent males’ poor mental health and health-compromising behaviours: A factor analysis model on Swedish school-based data. Scand. J. Public Health 2022, 50, 232–244. [Google Scholar] [CrossRef] [PubMed]
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. Lancet 2011, 377, 1162–1174. [Google Scholar]
- Hjern, A.; Arat, A.; Vinnerljung, B. Att Växa Upp Med Föräldrar Som Har Missbruksproblem Eller Psykisk Sjukdom—Hur Ser Livet ut i Ung Vuxen Ålder? Available online: https://anhoriga.se/globalassets/media/dokument/barn-som-anhorig/rapporter-och-publikationer/rapporter/bsa_chess-4_webbny.pdf (accessed on 16 February 2023).
- Hjern, A.; Manhica, H. Barn Som Anhöriga till Patienter i Vården-Hur Många är de? Available online: https://anhoriga.se/globalassets/media/dokument/barn-som-anhorig/rapporter-och-publikationer/rapporter/nka_rapport_barn_som_anhoriga_2013-1.pdf (accessed on 30 August 2023).
- Smith, G.L.; McGuinness, T.M. Adolescent Psychosocial Assessment: The HEEADSSS. J. Psychosoc. Nurs. Ment. Health Serv. 2017, 55, 24–27. [Google Scholar] [CrossRef] [PubMed]
- Haraldsson, J.; Pingel, R.; Nordgren, L.; Johnsson, L.; Kristiansson, P.; Tindberg, Y. Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health: A structural equation modelling approach. Scand. J. Prim. Health Care 2022, 40, 438–449. [Google Scholar] [CrossRef]
- Marshall, S.; Fearnley, R.; Bristowe, K.; Harding, R. The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis. Palliat. Med. 2021, 35, 246–260. [Google Scholar] [CrossRef]
- Rowe, S.; French, R.; Henderson, C.; Henderson, D.; Slade, M.; Moran, P. Help-seeking behaviour and adolescent self-harm: A systematic review. Aust. N. Z. J. Psychiatry 2014, 48, 1083–1095. [Google Scholar] [CrossRef] [PubMed]
Included Variables | No RSHC * n (%) | Any RSHC # n (%) | p-Value £ |
---|---|---|---|
Total | 1636 (47) | 1847 (53) | |
Gender | <0.001 | ||
Boy | 939 (57) | 855 (46) | |
Girl | 697 (43) | 992 (54) | |
Background variables | |||
Grade | 0.31 | ||
Y9 (15–16 years) | 883 (54) | 965 (52) | |
Y2U (17–18 years) | 753 (46) | 882 (48) | |
Ethnicity | <0.001 | ||
Swedish | 1164 (71) | 1479 (80) | |
Non-Swedish | 472 (29) | 368 (20) | |
No economic stress $ | <0.001 | ||
Yes | 1474 (90) | 1518 (82) | |
No | 62 (10) | 329 (18) | |
School-related factors | |||
Not being bullied at school $ | <0.001 | ||
Yes | 1454 (89) | 1533 (83) | |
No | 182 (11) | 314(17) | |
Enjoying school | <0.001 | ||
Yes | 1266 (77) | 1298 (70) | |
No | 370 (23) | 549 (30) | |
Home-related factors | |||
Feeling safe at home | <0.001 | ||
Yes | 1525 (93) | 1589 (86) | |
No | 111 (7) | 258 (14) | |
Living with both parents | <0.001 | ||
Yes | 1085 (66) | 1023 (55) | |
No | 551 (33) | 824 (45) | |
Safety in everyday life | |||
Not being violated via social media $ | <0.001 | ||
Yes | 1377 (84) | 1357 (74) | |
No | 259 (16) | 490 (27) | |
Feeling happy about life | <0.001 | ||
Yes | 1439 (88) | 1479 (80) | |
No | 506 197 (12) | 368 (20) | |
Feeling happy with leisure | <0.001 | ||
Yes | 1314 (80) | 1317 (71) | |
No | 242 (20) | 530 (29) | |
Lifestyle factors | |||
Having dinner daily | 0.04 | ||
Yes | 1390 (85) | 1502 (81) | |
No | 246 (15) | 345 (19) | |
Falling asleep well $ | <0.001 | ||
Yes | 1191 (73) | ||
No | 445 (27) | 458 (34) | |
Getting good sleep $ | <0.001 | ||
Yes | 1418 (87) | 1441 (78) | |
No | 218 (13) | 406 (22) | |
No use of alcohol $ | <0.001 | ||
Yes | 794 (49) | 667 (36) | |
No | 842 (51) | 1180 (64) |
Girls’ Poor Mental Health | Boys’ Poor Mental Health | |||||
---|---|---|---|---|---|---|
Type of RSHC | No n (%) | Yes n (%) | p-Value * | No n (%) | Yes n (%) | p-Value * |
Physical illness (PI) | <0.001 | 0.002 | ||||
No RSHC | 278 (40) | 419 (60) | 609 (65) | 330 (35) | ||
PI only | 17 (24) | 55 (76) | 46 (57) | 34 (43) | ||
PI + ≥1 other RSHC | 46 (16) | 250 (85) | 105 (48) | 113 (52) | ||
Total | 341 (32) | 724 (68) | 760 (61) | 477 (39) | ||
Mental illness (MI) | <0.001 | <0.001 | ||||
No RSHC | 278 (40) | 419 (60) | 609 (65) | 330 (35) | ||
MI only | 21 (25) | 64 (75) | 25 (46) | 30 (55) | ||
MI + ≥1 other RSHC | 53 (17) | 269 (84) | 107 (47) | 119 (53) | ||
Total | 352 (32) | 752 (68) | 741 (61) | 479 (40) | ||
Substance abuse/ gambling (SAG) | <0.001 | <0.001 | ||||
No RSHC | 278 (40) | 419 (60) | 609 (65) | 330 (35) | ||
SAG only | 15 (32) | 32 (68) | 11 (48) | 12 (52) | ||
SAG + ≥1 other RSHC | 42 (18) | 200 (83) | 79 (42) | 108 (58) | ||
Total | 335 (34) | 651 (66) | 699 (61) | 450 (40) | ||
Died (D) | <0.001 | <0.001 | ||||
No RSHC | 378 (40) | 419 (60) | 609 (65) | 330 (35) | ||
D only | 111 (36) | 199 (64) | 193 (56) | 152 (44) | ||
D + ≥1 other RSHC | 76 (19) | 315 (81) | 135 (45) | 165 (55) | ||
Total | 465 (33) | 933 (67) | 937 (59) | 647 (41) |
Girls’ NSSI | Boys NSSI | |||||
---|---|---|---|---|---|---|
Type of RSHC | No n (%) | Yes n (%) | p-Value * | No n (%) | Yes n (%) | p-Value * |
Physical illness (PI) | <0.001 | 0.002 | ||||
No RSHC | 579 (83) | 116 (17) | 836 (88) | 105 (11) | ||
PI only | 57 (80) | 14 (20) | 69 (86) | 11 (14) | ||
PI + ≥1 other RSHC | 179 (61) | 116 (40) | 174 (80) | 44 (20) | ||
Total | 815 (246) | 246 (23) | 1079 (87) | 160 (13) | ||
Mental illness (MI) | <0.001 | <0.001 | ||||
No RSHC | 579 (83) | 116 (17) | 836 (89) | 105 (11) | ||
MI only | 65 (77) | 20 (24) | 43 (78) | 12 (22) | ||
MI + ≥1 other RSHC | 189 (60) | 132 (41) | 177 (78) | 49 (22) | ||
Total | 833 (76) | 268 (24) | 1056 (86) | 166 (14) | ||
Substance abuse/ gambling (SAG) | <0.001 | <0.001 | ||||
No RSHC | 579 (83) | 116 (17) | 836 (89) | 105 (11) | ||
SAG only | 34 (72) | 13 (28) | 18 (78) | 5 (22) | ||
SAG + ≥1 other RSHC | 141 (58) | 101 (42) | 135 (72) | 53 (28) | ||
Total | 754 (76) | 230 (23) | 989 (86) | 163 (14) | ||
Died (D) | <0.001 | <0.001 | ||||
No RSHC | 579 (83) | 116 (17) | 836 (89) | 105 (11) | ||
D only | 249 (80) | 61 (20) | 304 (88) | 40 (12) | ||
D + ≥1 other RSHC | 253 (65) | 137 (35) | 233 (77) | 68 (23) | ||
Total | 1081 (78) | 314 (23) | 1373 (86) | 213 (13) |
Poor Mental Health Girls | Poor Mental Health Boys | |||
---|---|---|---|---|
Model 1 | Model 2 | Model 1 | Model 2 | |
RSHC | ||||
Physical illness (PI) | ||||
No RSHC | 1 | 1 | 1 | 1 |
PI only | 1.99 (1.23–3.53) | 1.63 (0.87–3.01) | 1.42 (0.89–2.28) | 1.43 (0.84–2.43) |
PI + ≥1 other RSHC | 3.07 (2.15–4.39) | 1.84 (1.23–2.74) | 1.74 (1.28–2.38) | 1.23 (0.86–1.76) |
Mental illness (MI) | ||||
No RSHC | 1 | 1 | 1 | 1 |
MI only | 1.70 (1.00–2.88) | 1.40 (0.78–2.52) | 2.17 (1.24–3.79) | 1.74 (0.92–3.28) |
MI + ≥1 other RSHC | 2.85 (2.03–4.00) | 1.60 (1.09–2.35) | 1.82 (1.34–2.64) | 1.24 (0.87–1.76) |
Substance abuse/ gambling (SAG) | ||||
No RSHC | 1 | 1 | 1 | 1 |
SAG only | 1.21 (0.63–2.31) | 0.80 (0.37–1.17) | 1.48 (0.62–3.57) | 1.05 (0.39–2.81) |
SAG + ≥1 other RSHC | 2.68 (1.85–3.90) | 1.67 (1.09–2.26) | 2.26 (1.63–3.14) | 1.35 (0.91–1.99) |
Died (D) | ||||
No RSHC | 1 | 1 | 1 | 1 |
D only | 1.16 (0.88–1.54) | 0.98 (0.71–1.34) | 1.48 (1.46–1.91) | 1.58 (1.19–2.09) |
D + ≥1 other RSHC | 2.45 (1.80–3.27) | 1.58 (1.26–2.22) | 2.01 (1.60–2.74) | 1.40 (1.02–1.91) |
NSSI Girls | NSSI Boys | |||
---|---|---|---|---|
Model 1 | Model 2 | Model 1 | Model 2 | |
RSHC | ||||
Physical illness (PI) | ||||
No RSHC | 1 | 1 | 1 | 1 |
PI only | 1.16 (0.62–2.16) | 0.88 (0.44–1.74) | 1.30 (0.67–2.55) | 1.45 (0.55–2.38) |
PI + ≥1 other RSHC | 2.89 (2.11–3.97) | 1.64 (1.14–2.35) | 1.83 (1.23–2.72) | 1.32 (0.85–2.04) |
Mental illness (MI) | ||||
No RSHC | 1 | 1 | 1 | 1 |
MI only | 1.22 (0.70–2.13) | 0.78 (0.41–1.49) | 2.27 (1.14–4.50) | 1.57 (0.74–3.34) |
MI + ≥1 other RSHC | 2.89 (2.12–3.95) | 1.63 (1.14–2.32) | 1.99 (1.35–2.94) | 1.24 (0.80–1.92) |
Substance abuse/ gambling (SAG) | ||||
No RSHC | 1 | 1 | 1 | 1 |
SAG only | 1.68 (0.85–3.35) | 0.96 (0.44–2.10) | 1.86 (0.65–5.35) | 1.31 (0.44–3.89) |
SAG + ≥1 other RSHC | 3.02 (2.16–4.23) | 1.66 (1.12–2.46) | 2.92 (1.98–4.31) | 1.72 (1.14–2.67) |
Died (D) | ||||
No RSHC | 1 | 1 | 1 | 1 |
D only | 1.16 (0.82–1.65) | 1.14 (0.78–1.67) | 1.11 (0.75–1.65) | 1.09 (0.72–1.66) |
D + ≥1 other RSHC | 2.27 (1.68–3.01) | 1.45 (1.03–2.03) | 2.29 (1.61–3.23) | 1.40 (0.96–2.06) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tindberg, Y.; Tiikkaja, S. Adolescents’ Experiences of Close Relatives Having Physical Illness, Mental Illness, Addiction/Gambling Disorders, or Death Are Associated with Poor Mental Health and Non-Suicidal Self-Injury. Psychiatry Int. 2023, 4, 380-393. https://doi.org/10.3390/psychiatryint4040034
Tindberg Y, Tiikkaja S. Adolescents’ Experiences of Close Relatives Having Physical Illness, Mental Illness, Addiction/Gambling Disorders, or Death Are Associated with Poor Mental Health and Non-Suicidal Self-Injury. Psychiatry International. 2023; 4(4):380-393. https://doi.org/10.3390/psychiatryint4040034
Chicago/Turabian StyleTindberg, Ylva, and Sanna Tiikkaja. 2023. "Adolescents’ Experiences of Close Relatives Having Physical Illness, Mental Illness, Addiction/Gambling Disorders, or Death Are Associated with Poor Mental Health and Non-Suicidal Self-Injury" Psychiatry International 4, no. 4: 380-393. https://doi.org/10.3390/psychiatryint4040034